Youth Services Navigation Intervention for HIV+ adolescents and young adults being released from incarceration: A randomized control trial

针对出狱的艾滋病毒青少年和年轻人的青年服务导航干预：一项随机对照试验

• 批准号: 9540937
• 负责人: MARVIN E BELZER
• 金额: $ 71.99万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-08-08 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9540937
• 关键词: Acute; Address; Adherence; Adolescent; Adolescent and Young Adult; Adult; Alcohol or Other Drugs use; Bisexual; Caring; Cellular Phone; Chicago; Community Health Services; Community Services; Comorbidity; Continuity of Patient Care; County; Criminal Justice; Effectiveness; Enrollment; Ensure; Food; Gays; General Population; HIV; HIV diagnosis; Healthcare; Homelessness; Housing; Imprisonment; Incentives; Incidence; Intervention; Jail; Latino; Link; Los Angeles; Medical; Mental Health; Mental Health Services; Outcome; Participant; Patient Self-Report; Persons; Population; Prevalence; Probability; Problem Solving; Provider; Randomized; Randomized Controlled Trials; Reporting; Resources; Sampling; Services; Sexual and Gender Minorities; Shelter facility; Substance Use Disorder; System; Testing; Time; Training; Transportation; Viral; Viral Load result; Work; Youth; aged; antiretroviral therapy; clinical care; community reentry; contingency management; control trial; cost; evidence base; experience; health service use; high risk; improved; innovation; intervention effect; intervention participants; men; men who have sex with men; navigator intervention; peer; public health relevance; recidivism; response; successful intervention; therapy adherence; transgender women; trial design; usual care arm; viral RNA; young men who have sex with men

Project Summary/Abstract The continuum of HIV care has forced new focus on the urgency to identify and effectively serve high-need, under-resourced, and often transient populations to facilitate their receiving the necessary ongoing care and antiretroviral therapy (ART) to suppress HIV RNA viral load (VL). Crucial target groups for improving care along the continuum are young (aged 16-25), sexual and gender minority (SGM) populations being released from jail settings. HIV prevalence among incarcerated youth living with HIV (YLWH) is three times that of the general population and one in seven of all HIV+ persons experience incarceration each year. HIV incidence, prevalence, and incarceration rates are higher for blacks and Latinos than for any other group – these disparities are especially prominent among youth. Furthermore, only an estimated 6% of HIV+ youth are virally suppressed, due to poor retention and adherence to ART. Existing linkage and retention services are insufficient to meet the acute needs of criminal justice-involved (CJI) HIV+ youth, particularly in the high-need period following release from incarceration. Moreover, because of their lack of experience, many youths may struggle to obtain needed services and stabilize their living conditions. Disparities in HIV continuum outcomes are inextricably linked to incarceration, substance use disorders (SUDs), homelessness, and mental health (MH) problems among YLWH. If HIV is to be controlled and the benefits of ART experienced broadly, the problems of CJI YLWH must be addressed with innovative, youth-, and sexual and gender minority (SGM)- sensitive approaches. We propose to enroll 240 CJI YLWH, aged 16-25, incarcerated in Los Angeles and Chicago jails and juvenile detention facilities. We will randomize participants to the YSN intervention (n=120) vs. a usual-care control group (n=120). The youth services navigators (YSNs) will assist with addressing immediate unmet needs such as housing, transportation, and food prior to clinical care and ongoing; will guide intervention participants to a range of community services to support progress along the continuum of HIV care; and will provide direct ART adherence support. The proposed study has two Primary Specific Aims: 1. Adapt an existing peer navigation intervention for adults to create a Youth Service Navigation (YSN) intervention sensitive to SGM culture that guides youth to needed services along the continuum of HIV care. This intervention combines medical, substance use and mental health care with comprehensive reentry support for CJI YLWH, aged 16-25 upon release from large county jails and juvenile detention systems; 2. Using a two-group RCT design, we will test the effectiveness of the new YSN, youth SGM-sensitive intervention among CJI YLWH aged 16-25, compared to controls offered standard referrals to services. We will evaluate the YSN Intervention's effect on post-incarceration linkage, retention, adherence, and viral suppression, as well as on SUDs, mental health, services utilization, and met needs. Secondary Aims: We will assess YSN's effects on recidivism, costs and potential cost-offset/effectiveness.

项目总结/文摘